BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON
          BUSINESS, PROFESSIONS AND ECONOMIC DEVELOPMENT
                              Senator Jerry Hill, Chair
                                2015 - 2016  Regular 

          Bill No:            AB 2193         Hearing Date:    June 27,  
          2016
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          |Author:   |Salas                                                 |
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          |Version:  |April 5, 2016                                         |
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          |Urgency:  |No                     |Fiscal:    |Yes              |
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          |Consultant|Sarah Mason                                           |
          |:         |                                                      |
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            Subject:  California Board of Podiatric Medicine:  Physician  
                             Assistant Board:  extension


          SUMMARY:  Extends the operation of the Board of Podiatric Medicine  
          (BPM), the operation of the Physician Assistant Board (PAB), and  
          the PAB's authority to appoint an executive officer from January  
          1, 2017 to January 1, 2021.  

          Existing law: 

          1)Establishes the BPM within the jurisdiction of the Medical  
            Board of California (MBC) until January 1, 2017.  Provides  
            that the repeal of the enacting statute renders the BPM  
            subject to review by the appropriate policy committees of the  
            Legislature.  (Business and Professions Code (BPC) § 2460)
          2)Establishes the PAB within the jurisdiction of the MBC until  
            January 1, 2017.  Provides that the repeal of the enacting  
            statute renders the PAB subject to review by the appropriate  
            policy committees of the Legislature.  (BPC § 3504)


          3)Requires, until January 1, 2017, and except as provided in BPC  
            §§ 159.5 and 2020, the PAB to employ within the limits of the  
            Physician Assistant Fund all personnel necessary to carry out  
            the provisions of the Physician Assistant Practice Act,  
            including an executive officer who shall be exempt from civil  
            service.  Requires the MBC and PAB to make all necessary  
            expenditures to carry out the provisions of the Physician  







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            Assistant Practice Act from the Physician Assistant Fund.   
            (BPC § 3512) 


          This bill:

          1)Extends the sunset dates for the BPM and the PAB until January  
            1, 2021.


          2)Extends the PAB's authority to appoint an executive officer  
            until January 1, 2021.



          FISCAL EFFECT:  This bill is keyed "fiscal" by Legislative  
          Counsel.  According to the Assembly Committee on Appropriations  
          analysis dated April 20, 2016, this bill will result in costs of  
          approximately $1.5 million per year for four additional calendar  
          years to continue the operation of the BPM and costs of  
          approximately $1.6 million per year for four additional calendar  
          years to continue the operation of the PAB.

          


          COMMENTS:

          1. Purpose.  This bill is sponsored by the Author  , and is one of  
             five "sunset bills" the Author is sponsoring this Session.   
             According to the Author, "because the boards are set to  
             sunset in 2017, the date needs to be extended to ensure the  
             continued regulation of the professions."

          2. Oversight Hearings and Sunset Review of Licensing Boards and  
             Programs.  Beginning in 2015, the Senate Business and  
             Professions Committee and the Assembly Business and  
             Professions Committee (Committees) conducted joint oversight  
             hearings to review 12 regulatory entities:  Department of  
             Consumer Affairs (DCA), Acupuncture Board, Board of  
             Behavioral Sciences, California Massage Therapy Association,  
             Court Reporters Board, Board of Pharmacy, PAB, BPM, Bureau  
             for Private Postsecondary Education (BPPE), Board of  
             Psychology, Bureau of Real Estate, Bureau of Real Estate  








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             Appraisers and Veterinary Medical Board.

             The Committees conducted two hearings in March.  This bill  
             and the accompanying sunset bills are intended to implement  
             legislative changes as recommended by staff of the Committees  
             and which are reflected in the Background Papers prepared by  
             Committee staff for each agency and program reviewed this  
             year.

          3. Background on BPM.  BPM is a licensing board under the DCA.   
             BPM licenses and regulates doctors of podiatric medicine  
             (DPMs). In the Medical Practice Act, a license to practice  
             podiatric medicine is called a "certificate," but it is  
             indistinguishable from other professional licenses.  It is a  
             misdemeanor to practice podiatric medicine or use the title  
             DPM, podiatrist, or similar designation without a license.   
             The Practice Act defines "podiatric medicine" as all medical  
             treatment of the foot, ankle, and tendons that insert into  
             the foot, including diagnosis, surgery, and the nonsurgical  
             treatment of the muscles and tendons of the leg governing the  
             functions of the foot. Therefore, a DPM's scope of practice  
             is similar to that of a physician and surgeon who specializes  
             in the foot and ankle.  However, unlike a physician and  
             surgeon, whose scope is only limited by the licensee's own  
             area of competence, a DPM's scope is limited by the license  
             to the foot and ankle.  Historically, the BPM was a committee  
             within the Medical Board of California (MBC).  Currently,  
             however, the BPM functions as an independent board, similar  
             to other licensing boards under the DCA.  Still, the Practice  
             Act continues to describe the BPM as "within the jurisdiction  
             of" the MBC. As a result, the BPM makes recommendations for  
             DPM licensure to the MBC, while the MBC officially issues the  
             licenses, but defers completely to the judgment of BPM.  The  
             BPM licenses approximately 2,000 DPMs. On average, it issues  
             106 licenses each year and renews on average 1,106 licenses  
             each year.
             
             As a special fund agency, the BPM receives no general funds.   
             Instead, it relies on fees set by statute and collected from  
             licensing and renewal.  The purpose of the BPM's licensing  
             program is to protect the public and consumers by ensuring  
             minimum competency in practitioners. Applicants for a DPM  
             license must graduate from a college of podiatric medicine  
             that has been approved by the BPM, pass Part I, II and III of  








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             the national exam and successfully complete two years of  
             postgraduate training.

          4. Review of the BPM - Issues Identified and Recommended  
             Changes.  Committee staff identified 11 issues pertaining to  
             BBS and provided background information concerning each  
             issue.  Recommendations were made by Committee staff  
             regarding the particular issue areas which needed to be  
             addressed.  Only one of the identified issues for BPM  
             required a statutory change.  
             
              a)   Issue  :  Continued Regulation of the Profession by BPM.
                
               Background  :  The health, safety and welfare of consumers  
               are protected by the presence of a strong licensing and  
               regulatory board with oversight over DPMs.  The BPM has  
               shown a commitment to its mission and a willingness to work  
               with the legislature to improve consumer protection.  
               Therefore, the BPM should be continued with a 4-year  
               extension of its sunset date so that the Legislature may  
               once again review whether the issues and recommendations in  
               this Background Paper have been addressed.

                Recommendation and Proposed Statutory Change  : The committee  
               recommends that DPMs continue to be regulated by the  
               current the BPM members in order to protect the interests  
               of the public and be reviewed again in four years.

               This bill extends the operation of BPM for four years.
          
          5. Background on PAB.  PAB is also a licensing board under DCA.   
             PAB licenses and regulates physician assistants (PAs). PAs  
             provide health care services under the supervision of a  
             physician and surgeon.  PA functions include performing  
             diagnostic, therapeutic, preventive, and health maintenance  
             services. Currently, the PAB has over 10,000 licensed PAs.   
             Historically, the PAB was a committee within the MBC,  
             however, the current PAB is an independent board with  
             regulatory authority to enforce the Physician Assistant   
             Practice Act.  The PAB still utilizes many of the MBC's  
             services, including enforcement, information technology, and  
             fund management via a contract with MBC. 

             The PAB's mandates include:








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                       Approval of the educational and training  
                  requirements of PAs
                       Licensing of PAs.
                       Promoting the health and safety of California  
                  health care consumers by enhancing the competence of  
                  PAs.
                       Coordinating investigation and disciplinary  
                  processes
                       Providing information and education regarding the  
                  PAB or PA professionals to California consumers.
                       Managing a diversion/monitoring program for PAs  
                  with alcohol/substance abuse problems.

          1. Review of PAB - Issues Identified and Recommended Changes.   
             Committee staff identified 10 issues pertaining to PAB and  
             provided background information concerning each issue.   
             Recommendations were made by Committee staff regarding the  
             particular issue areas which needed to be addressed.  Only  
             one of the identified issues for PAB required a statutory  
             change.  
             
              a)   Issue  :  Continued Regulation of the Profession.
                
               Background  :  The health, safety and welfare of consumers  
               are protected by the presence of a strong licensing and  
               regulatory board with oversight over PAs. The PAB has shown  
               a commitment to improve its overall efficiency and  
               effectiveness and has worked cooperatively with the  
               Legislature and the Committees to bring about necessary  
               changes. Therefore, the PAB should be continued with a 
               4-year extension of its sunset date so that the Legislature  
               may once again review whether the issues and  
               recommendations in this Background Paper have been  
               addressed.
                
               Recommendation and Proposed Statutory Change  : The licensing  
               and regulation of PAs should continue to be regulated by  
               the current members of the PAB in order to protect the  
               interests of the public and be reviewed once again in four  
               years.

               This bill extends the operation of PAB and PAB's authority  
               to appoint an EO for four years.








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          2. Related Legislation This Year.   SB 1039  (Hill), among other  
             changes to the operations and fee structure of a number of  
             boards under DCA, gives BPM their own chapter in the Business  
             and Professions Code and formally separates it from the  
             Medical Board, reflecting operational realities.  (  Status:    
             The bill is currently pending in the Assembly Committee on  
             Business and Professions.)   

          
          SUPPORT AND OPPOSITION:
          
           Support:  

          California Academy of Physician Assistants

           Opposition:  

          None on file as of June 21, 2016.


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